Healthcare Provider Details

I. General information

NPI: 1013509520
Provider Name (Legal Business Name): LOUISA BORECKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2021
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 TOUCHSTONE APT 158
LAKE OSWEGO OR
97035-1967
US

IV. Provider business mailing address

4 TOUCHSTONE APT 158
LAKE OSWEGO OR
97035-1967
US

V. Phone/Fax

Practice location:
  • Phone: 541-816-8945
  • Fax:
Mailing address:
  • Phone: 541-816-8945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberR9094
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: